Adolescent neuropsychological development after early right prefrontal cortex damage

Adolescent development and pattern of recovery are described for a 15-year- old boy who sustained extensive right dorsolateral prefrontal cortex damage at age 7 from rupture and surgical treatment of a deep arteriovenous malfo rmation. Follow-up evaluations at 4 years and most recently 8 years after i llness have shown clear improvement in social-behavioral and almost all cog nitive areas initially assessed. He demonstrated resolution of left hemispa tial neglect and other visuospatial impairments in working memory, design f luency, and planning and organization. However, at the 8-year follow-up int erval, an acquired form of attention deficit disorder remains evident. We h ypothesized that this is the likely cause of comparatively lower scores in general intelligence, verbal learning and memory, discourse, and processing speed, than at the 4-year follow-up interval. New measures of emotional fa ce and voice recognition showed only minor difficulties, principally in ide ntifying vocal disgust and fear. Social and psychological maturation has co ntinued to improve, with no evidence of developmental arrest or pervasive s ocial impairment, although the individual is confused at times by complexit ies and nuances of social interaction. The pattern of findings 8 years afte r early right dorsolateral prefrontal cortex damage suggests remarkable rec overy of primary visuospatial and social impairments, but lingering and som ewhat worsening performance deficits which may be due to attentional diffic ulties and impulsive responding. Treatment of the attentional difficulties is currently being investigated.